Reflections on Learning and Motor Skills Disorders

Learning and Motor Skills Disorders as a category generally lump together learning disabilities (LD) including those associated with reading, written expression, mathematics, and motor control (developmental coordination disorder).  It’s important to note that the category of LD is rooted in the education field, not the medical, and that “individuals identified as having a learning disability constitute a highly heterogeneous group.”  (Netherton, Holmes, & Walker, 1999, p. 25)  Additionally, because so many disciplines serve the LD population, there is no standard definition for LD.  Although it might appear to be a matter of semantics, the definition does seem to matter… especially when it comes to who qualifies for a$$i$tance.

Regardless of what definition you choose, or what discipline you yield from, discrepancy is a key concept.  Learning Disorders (formerly Academic Skills Disorders) are diagnosed when the individual’s achievement on individually administered, standardized tests in reading, mathematics, or written expressions is substantially below that expected for age, schooling, and level of intelligence.  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 49)  While there are a whole host of dimensional aspects we could use to measure discrepancy, it suffices to say that if there is a clinically significant delta between “the norm” and your client, the first pre-requisite is met.

Also implicit in the diagnosis of LD disorders is the concept of exclusion.  Learning Disorders must be differentiated from normal variations in academic attainment and from scholastic difficulties due to lack of opportunity, poor teaching, or cultural factors.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 51)  In addition, we should pay specific attention to special provisions we may need to provide for individuals with impaired vision or hearing, mental retardation.

Motor Skills Disorder presents us with a different set of challenges, including marked impairment in the development of motor concentration and/or significant interference with academic achievement or daily living.  Exclusions include various medical conditions, or mental retardation (unless the impairment exceeds what is usually associated with mental retardation).  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 57)

On the whole, what surprised me most was that all learning disabilities are more prevalent in males than they are in females.  It was suggested in both the DSM –IV-R and the text that the increased attention to males may be due to sampling errors, or simply that males are more subject to behavior disorders.  I tend to think it’s the latter, it seems reasonable.

I also noticed that the statement that “the relative lack of specificity of the DSM-IV categories may serve to decrease their clinical usefulness.”  (Netherton et al., 1999, p. 28)  It’s evident to me that we intend to serve this population well we are going to have to team with the disciplines that “own” LD, namely education.  Reading and writing about learning disorders, I got the feeling that we, as psychologists, weren’t “on our home field” when discussing it.  Perhaps some of the other disciplines (educators) probably have more influence over it?

I think the concept of “learned helplessness” is also important to consider when diagnosing LD’s.  Perhaps we can contribute to growth though exercises that enrich and fortify self-image, self esteem, and motivational training.

Anyone reading this, or am I talking to myself? 😉

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Reflections on Mental Retardation

Although it is not the most politically correct term for the condition, mental retardation (MR) is still has significant presence in the populations we counselors intend to serve.  It is well documented that individuals with MR are at higher risk for comorbid mental illness of virtually all flavors…

Despite our best efforts to serve this needy population, interdisciplinary approaches that are considered ideal are still infrequently deployed due to cost and time constraints.   I am surprised and disappointed that this kind of consideration isn’t arranged for everyone dually diagnosed with MR and a comorbid mental illness.  I believe if we engaged TEAMS of psychologists, social workers, teachers, and communities agencies at every level of care and integrated it into a cohesive whole, the individuals we serve would receive a higher level of care for a LOWER COST!

A natural extension of the interdisciplinary approach is the involvement of the family in the decision-making process.  (Netherton, Holmes, & Walker, 1999, p. 19)  The importance of the family can not be overstated… absolutely critical and nothing less. I think this approach is too often implied and too rarely explicit.  Three key tenets to working with families are not to be overlooked:

1)      The team must be receptive to including families in the decision making process.

2)      The team must consider the level of knowledge and understanding of the family related to the disability of the child and/or the service and treatment options.

3)      Once the family has an adequate understanding of the condition and service and treatment alternatives, they may need to be nurtured through the team decision making process.  (Netherton et al., 1999, p. 21)

We, as practicing clinicians and psychotherapists, could take a number of different roles in the team environment.  As facilitators, we should frequently be asking parents what their perspective is, constantly seeking feedback and nurturing their freedom of autonomy.   It is absolutely critical that the family “buys in.”  I believe that if we nurture their ability to participate, that “buy in” is much more likely.  As educators, we can also serve parents by helping them making informed decisions regarding every phase of the plan.

I think every expectant parent comes to the table with hopes, dreams, and expectations of who their child will become.  Because many of these children will never grow up and meet the expectations of their parents, we can play a role in assisting them in coping, or simply modifying or altering those expectations to coincide with the realities of raising a child who may never be cured of mental retardation.

As the plan unfolds, we as councilors can play a role not only in the development of the primary client, but we can play a developmental role in the lives of the family members.  If the family experiences feelings of shame, guilt, or even a certain sense of grief can be dealt with in a variety of different formats; including group therapy, family therapy, individual therapy, or even couples therapy for parents.

In summary, I hope we can come to consensus that psychologists should play a significant role in the planning and execution of any developmental plan involving a child with mental retardation.  I would advocate that, aside from the primary care givers and family, our ability to offer assistance at different points of entry uniquely positions us to fill the much needed gaps in the overall individual treatment plan.

Reference

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.